HomeMy WebLinkAbout7 OLD TOWN SQ - APPLICATIONS - 12/13/2010City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER .' V U (J� APPLICATION DATE_
Job Site Address- old 7 �� Unit #
PROPERTY OWNER INFO: (All owner information is required- /it is not optional) Phone #
Last name /-%%(%�{��� yJc�_ �j(�`./ 'rt'st ame Middle
Street Address 7�—S24_d Y% ri& Cityl'6}/� j��s' State_Zip
CONTRACTOR INFO: Company Name �'f . _� �l� ,'/�_/rL_ /� ��, Contractor Phone #� ��� �(��} _ �� c.'
Lic Holder Name 1 City of Fort Collins License # Supervisor Cert #
Mailing Address �� e�. �i � City State G��_ Zip Z
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'] Sq F # of Stories_ Bldg Height r� # Dwelling Units
151 Floor Sq Ft
2nd Floor Sq Ft
31d Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths '/z Baths # of. Fireplaces
Air Conditioning: / Yew No Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Bloweerr Door 4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
List appropriate option #s
Water Tap Size Sewer Tap Size Metered: Yes or No Temp. Pedestal Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less ❑ 200 Amp [:]Other
Value of Construction (including labor, material & profit)
Description of Work:tv,Sfa
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
it
(2�
Plumbing
Fireplace
Other
Applicant: I hereby acknowledg hat I have read this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of F Collins ordinances and state laws regulating building cons ruction.
Applicant Signature Print Name one 7e9 o%d-�y
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE